Provider Demographics
NPI:1134696644
Name:THOMAS, ADRIAN K (PTA)
Entity type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:K
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SYLVAN RD S FL 1
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-4639
Mailing Address - Country:US
Mailing Address - Phone:203-854-5100
Mailing Address - Fax:
Practice Address - Street 1:3 SYLVAN RD S FL 1
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-4639
Practice Address - Country:US
Practice Address - Phone:203-854-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001642225200000X
CT001624225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant